Steinstraesser Lars, Wehner Martin, Trust Galina, Sorkin Michael, Bao Denxia, Hirsch Tobias, Sudhoff Holger, Daigeler Adrien, Stricker Ingo, Steinau Hans-Ulrich, Jacobsen Frank
Department of Plastic Surgery, Burn Center, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789 Bochum, Germany.
Lasers Surg Med. 2010 Feb;42(2):141-9. doi: 10.1002/lsm.20901.
Collagen scaffolds are popular for the reconstitution of dermal equivalents. Usually, these scaffolds are fixed with sutures or staples and in many cases these devices have to be removed in a second procedure. Laser-mediated tissue welding in a wet environment is a potential alternative for collagen scaffold fixation and may be advantageous to suture, staple, and tissue glue fixation.
Welding was performed with a continuous-wave diode laser system emitting radiation at a wavelength of 968 nm. Tensile strength after fixation to porcine skin and laser parameters were determined in vitro. In vivo, 24 excisional deep partial thickness wounds were created on flanks of two Goettingen mini pigs and covered with collagen scaffolds. These were randomized and fixated with either (1) staples, (2) fibrin glue, or (3) laser-mediated welding. Tissue biopsies for histological analysis were periodically performed and analyzed for wound healing progression, epidermal thickness, and extracellular matrix formation.
Biomechanical stability after laser welding was time dependent. A dwell time of up to 10 seconds led to a strong bonding with a tensile strength of more than 30 g. In vivo, the wound healing process was macroscopically comparable in all groups and showed no significant differences. Microscopic analysis determined a more progressed and quicker wound closure in both the laser and staples group compared to the fibrin glue fixated scaffold. Laser-mediated fixation led to a significantly reduced epidermal thickness when compared with stapling or fibrin glue (P < 0.05).
Laser tissue welding is a feasible approach for temporary fixation of collagen scaffolds to the wound bed. It improves wound healing properties and may lead to faster wound healing and cosmetically better scarring. Laser tissue welding is thus a very interesting and promising alternative to currently established fixation methods in a single step, no touch procedure.
胶原蛋白支架在真皮替代物的重建中很受欢迎。通常，这些支架用缝线或吻合钉固定，在许多情况下，这些装置必须在第二步手术中取出。在潮湿环境中进行激光介导的组织焊接是胶原蛋白支架固定的一种潜在替代方法，可能比缝线、吻合钉和组织胶水固定更具优势。
使用发射波长为968nm辐射的连续波二极管激光系统进行焊接。在体外测定固定到猪皮后的拉伸强度和激光参数。在体内，在两只哥廷根小型猪的侧腹上制造24个切除性深Ⅱ度伤口，并用胶原蛋白支架覆盖。将它们随机分组，并用以下方法固定：（1）吻合钉，（2）纤维蛋白胶，或（3）激光介导焊接。定期进行组织活检以进行组织学分析，并分析伤口愈合进程、表皮厚度和细胞外基质形成情况。
激光焊接后的生物力学稳定性与时间有关。长达10秒的停留时间会导致牢固结合，拉伸强度超过30克。在体内，所有组的伤口愈合过程在宏观上具有可比性，且无显著差异。显微镜分析确定，与纤维蛋白胶固定的支架相比，激光组和吻合钉组的伤口闭合更进展且更快。与吻合钉或纤维蛋白胶固定相比，激光介导固定导致表皮厚度显著降低（P<0.05）。
激光组织焊接是将胶原蛋白支架临时固定到伤口床的一种可行方法。它改善了伤口愈合特性，可能导致更快的伤口愈合和美容效果更好的瘢痕形成。因此，激光组织焊接是目前既定固定方法的一种非常有趣且有前景的替代方法，可在一步无接触手术中实现。
